{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:53:59Z","timestamp":1790776439395,"version":"4.1.0"},"reference-count":64,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Advisory Committee on Immunization","award":["contract no. 4600001536"],"award-info":[{"award-number":["contract no. 4600001536"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,4,21]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Rapid review to determine the magnitude of association between potential risk factors and severity of COVID-19, to inform vaccine prioritisation in Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ovid MEDLINE(R) ALL, Epistemonikos COVID-19 in L\u00b7OVE Platform, McMaster COVID-19 Evidence Alerts and websites were searched to 15 June 2020. Eligible studies were conducted in high-income countries and used multivariate analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>After piloting, screening, data extraction and quality appraisal were performed by a single experienced reviewer. Of 3740 unique records identified, 34 were included that reported on median 596 (range 44\u2013418\u2009794) participants, aged 42\u201384 years. 19\/34 (56%) were good quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Hospitalisation, intensive care unit admission, length of stay in hospital or intensive care unit, mechanical ventilation, severe disease, mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Authors synthesised findings narratively and appraised the certainty of the evidence for each risk factor\u2013outcome association. There was low or moderate certainty evidence for a large (\u22652-fold) magnitude of association between hospitalisation in people with COVID-19, and: obesity class III, heart failure, diabetes, chronic kidney disease, dementia, age &gt;45 years, male gender, black race\/ethnicity (vs non-Hispanic white), homelessness and low income. Age &gt;60\u2009and &gt;70 years may be associated with large increases in mechanical ventilation and severe disease, respectively. For mortality, a large magnitude of association may exist with liver disease, Bangladeshi ethnicity (vs British white), age &gt;45 years, age &gt;80 years (vs 65\u201369 years) and male gender among 20\u201364 years (but not older). Associations with hospitalisation and mortality may be very large (\u22655-fold) for those aged \u226560 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increasing age (especially &gt;60 years) may be the most important risk factor for severe outcomes. High-quality primary research accounting for multiple confounders is needed to better understand the magnitude of associations for severity of COVID-19 with several other factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42020198001.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-044684","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T13:19:12Z","timestamp":1620911952000},"page":"e044684","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":59,"title":["Risk factors for severity of COVID-19: a rapid review to inform vaccine prioritisation in Canada"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-5221","authenticated-orcid":false,"given":"Aireen","family":"Wingert","sequence":"first","affiliation":[{"name":"Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Pillay","sequence":"additional","affiliation":[{"name":"Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9941-9981","authenticated-orcid":false,"given":"Michelle","family":"Gates","sequence":"additional","affiliation":[{"name":"Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Guitard","sequence":"additional","affiliation":[{"name":"Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sholeh","family":"Rahman","sequence":"additional","affiliation":[{"name":"Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8308-2202","authenticated-orcid":false,"given":"Andrew","family":"Beck","sequence":"additional","affiliation":[{"name":"Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Vandermeer","sequence":"additional","affiliation":[{"name":"Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8341-3991","authenticated-orcid":false,"given":"Lisa","family":"Hartling","sequence":"additional","affiliation":[{"name":"Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"2025120519352716000_11.5.e044684.1","unstructured":"World Health Organization . Naming the coronavirus disease (COVID-19) and the virus that causes it, 2020. Available: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/technical-guidance\/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it [Accessed 31 Jul 2020]."},{"key":"2025120519352716000_11.5.e044684.2","unstructured":"World Health Organization . Coronavirus disease 2019 (COVID-19): situation report - 51. Geneva, Switzerland: World Health Organization, 2020. https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200311-sitrep-51-covid-19.pdf"},{"key":"2025120519352716000_11.5.e044684.3","unstructured":"World Health Organization . Coronavirus disease 2019 (COVID-19): weekly epidemiological update 17. Geneva, Switzerland: World Health Organization, 2020. https:\/\/www.who.int\/publications\/m\/item\/weekly-epidemiological-update-8-december-2020"},{"key":"2025120519352716000_11.5.e044684.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmaid.2020.101623"},{"key":"2025120519352716000_11.5.e044684.5","unstructured":"Government of Canada . Coronavirus disease 2019 (COVID-19): epidemiology update. Ottawa, Canada: Government of Canada, 2020. https:\/\/health-infobase.canada.ca\/src\/data\/covidLive\/Epidemiological-summary-of-COVID-19-cases-in-Canada-Canada.ca.pdf"},{"key":"2025120519352716000_11.5.e044684.6","unstructured":"World Health Organization . Accelerating a safe and effective COVID-19 vaccine. Geneva, Switzerland: World Health Organization, 2020. https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/global-research-on-novel-coronavirus-2019-ncov\/accelerating-a-safe-and-effective-covid-19-vaccine"},{"key":"2025120519352716000_11.5.e044684.7","unstructured":"Health Canada . Statement on UK\u2019s authorization of its first COVID-19 vaccine, manufactured by Pfizer\/BioNTech. Ottawa, Canada: Health Canada, 2020. https:\/\/www.canada.ca\/en\/health-canada\/news\/2020\/12\/statement-on-uks-authorization-of-its-first-covid-19-vaccine-manufactured-by-pfizerbiontech.html"},{"key":"2025120519352716000_11.5.e044684.8","unstructured":"Health Canada . Vaccines and treatments for COVID-19: progress. Ottawa, Canada: Health Canada, 2020. https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/2019-novel-coronavirus-infection\/prevention-risks\/covid-19-vaccine-treatment.html"},{"key":"2025120519352716000_11.5.e044684.9","unstructured":"World Health Organization . Draft landscape of COVID-19 candidate vaccines. Geneva, Switzerland: World Health Organization, 2020. https:\/\/www.who.int\/publications\/m\/item\/draft-landscape-of-covid-19-candidate-vaccines"},{"key":"2025120519352716000_11.5.e044684.10","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1038\/d41573-020-00073-5","article-title":"The COVID-19 vaccine development landscape","volume":"19","author":"Thanh Le","year":"2020","journal-title":"Nat Rev Drug Discov"},{"key":"2025120519352716000_11.5.e044684.11","unstructured":"Government of Canada . Research priorities for COVID-19 vaccines to support public health decisions. Ottawa, Canada: Government of Canada, 2020. https:\/\/www.canada.ca\/en\/public-health\/services\/immunization\/national-advisory-committee-on-immunization-naci\/research-priorities-covid-19-vaccines.html"},{"key":"2025120519352716000_11.5.e044684.12","unstructured":"Government of Canada . National Advisory Committee on immunization (NACI): membership and representation. Ottawa, Canada: Government of Canada, 2020. https:\/\/www.canada.ca\/en\/public-health\/services\/immunization\/national-advisory-committee-on-immunization-naci\/naci-membership-representation.html"},{"key":"2025120519352716000_11.5.e044684.13","doi-asserted-by":"crossref","first-page":"5861","DOI":"10.1016\/j.vaccine.2020.05.051","article-title":"A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations","volume":"38","author":"Ismail","year":"2020","journal-title":"Vaccine"},{"key":"2025120519352716000_11.5.e044684.14","doi-asserted-by":"publisher","DOI":"10.1076\/icsp.10.1.11.14117"},{"key":"2025120519352716000_11.5.e044684.15","doi-asserted-by":"crossref","unstructured":"Ismail SJ , Tunis MC , Zhao L . Navigating inequities: a roadmap out of the pandemic. BMJ 2020.","DOI":"10.2139\/ssrn.3695697"},{"key":"2025120519352716000_11.5.e044684.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2020.09.041"},{"key":"2025120519352716000_11.5.e044684.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.05.036"},{"key":"2025120519352716000_11.5.e044684.18","unstructured":"Tricco AC , Langlois EV , Straus SE , eds. Rapid reviews to strengthen health policy and systems: a practical guide. Geneva, Switzerland: World Health Organization, 2017."},{"key":"2025120519352716000_11.5.e044684.19","doi-asserted-by":"crossref","unstructured":"Higgins J , Thomas J , Chandler J . Cochrane handbook for systematic reviews of interventions. 2nd Edition. Chinchester, UK: John Wiley & Sons, 2019.","DOI":"10.1002\/9781119536604"},{"key":"2025120519352716000_11.5.e044684.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"2025120519352716000_11.5.e044684.21","unstructured":"Organisation for Economic Cooperation and Development . Member countries, 2020. Available: https:\/\/www.oecd.org\/about\/members-and-partners\/ [Accessed 24 Aug 2020]."},{"key":"2025120519352716000_11.5.e044684.22","unstructured":"Fraser Institute . Comparing performance of universal health care countries, 2019. Available: https:\/\/www.fraserinstitute.org\/studies\/comparing-performance-of-universal-health-care-countries-2019 [Accessed 24 Aug 2020]."},{"key":"2025120519352716000_11.5.e044684.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.08.005"},{"key":"2025120519352716000_11.5.e044684.24","unstructured":"Oliver S , Kavanagh J , Caird J . Health promotion, inequalities and young people\u2019s health: a systematic review of research. London, UK: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, 2008."},{"key":"2025120519352716000_11.5.e044684.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2011.06.004"},{"key":"2025120519352716000_11.5.e044684.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"2025120519352716000_11.5.e044684.27","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1136\/ebmed-2017-110668","article-title":"Rating the certainty in evidence in the absence of a single estimate of effect","volume":"22","author":"Murad","year":"2017","journal-title":"Evid Based Med"},{"key":"2025120519352716000_11.5.e044684.28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h870"},{"key":"2025120519352716000_11.5.e044684.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2019.10.014"},{"key":"2025120519352716000_11.5.e044684.30","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1377\/hlthaff.2020.00598","article-title":"Disparities in outcomes among COVID-19 patients in a large health care system in California","volume":"39","author":"Azar","year":"2020","journal-title":"Health Aff"},{"key":"2025120519352716000_11.5.e044684.31","doi-asserted-by":"crossref","unstructured":"Bhargava A , Fukushima EA , Levine M . Predictors for severe COVID-19 infection. Clin Infect Dis 2020.","DOI":"10.1093\/cid\/ciaa674"},{"key":"2025120519352716000_11.5.e044684.32","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-020-1389-1"},{"key":"2025120519352716000_11.5.e044684.33","doi-asserted-by":"crossref","DOI":"10.3390\/jcm9061733","article-title":"A cohort of patients with COVID-19 in a major teaching hospital in Europe","volume":"9","author":"Borobia","year":"2020","journal-title":"J Clin Med"},{"key":"2025120519352716000_11.5.e044684.34","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1002\/oby.22918","article-title":"Obesity and COVID-19: an Italian snapshot","volume":"28","author":"Busetto","year":"2020","journal-title":"Obesity"},{"key":"2025120519352716000_11.5.e044684.35","doi-asserted-by":"crossref","DOI":"10.3390\/jcm9051548","article-title":"Early predictors of clinical deterioration in a cohort of 239 patients hospitalized for COVID-19 infection in Lombardy, Italy","volume":"9","author":"Cecconi","year":"2020","journal-title":"J Clin Med"},{"key":"2025120519352716000_11.5.e044684.36","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2020.25.16.2000460","article-title":"Clinical characteristics of coronavirus disease (COVID-19) early findings from a teaching hospital in Pavia, North Italy, 21 to 28 February 2020","volume":"25","author":"Colaneri","year":"2020","journal-title":"Euro Surveill"},{"key":"2025120519352716000_11.5.e044684.37","doi-asserted-by":"crossref","unstructured":"Covino M , De Matteis G , Santoro M . Clinical characteristics and prognostic factors in COVID-19 patients aged >=80 years. Geriat Gerontol Int 2020.","DOI":"10.1111\/ggi.13960"},{"key":"2025120519352716000_11.5.e044684.38","doi-asserted-by":"crossref","unstructured":"Cummings MJ , Baldwin MR , Abrams D . Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. medRxiv 2020.","DOI":"10.1101\/2020.04.15.20067157"},{"key":"2025120519352716000_11.5.e044684.39","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-eular.1181"},{"key":"2025120519352716000_11.5.e044684.40","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1985"},{"key":"2025120519352716000_11.5.e044684.41","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1111\/anae.15170","article-title":"Risks to healthcare workers following tracheal intubation of patients with COVID\u201019: a prospective international multicentre cohort study","volume":"75","author":"El\u2010Boghdadly","year":"2020","journal-title":"Anaesthesia"},{"key":"2025120519352716000_11.5.e044684.42","doi-asserted-by":"crossref","DOI":"10.1016\/j.phrs.2020.104931","article-title":"30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: a prospective cohort study","volume":"158","author":"Giacomelli","year":"2020","journal-title":"Pharmacol Res"},{"key":"2025120519352716000_11.5.e044684.43","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6918e1"},{"key":"2025120519352716000_11.5.e044684.44","doi-asserted-by":"crossref","unstructured":"Hajifathalian K , Krisko T , Mehta A . Gastrointestinal and hepatic manifestations of 2019 novel coronavirus disease in a large cohort of infected patients from New York: clinical implications. Gastroenterol 2020.","DOI":"10.1053\/j.gastro.2020.05.010"},{"key":"2025120519352716000_11.5.e044684.45","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1002\/oby.22923","article-title":"Obesity is associated with worse outcomes in COVID-19: analysis of early data from New York City","volume":"28","author":"Hajifathalian","year":"2020","journal-title":"Obesity"},{"key":"2025120519352716000_11.5.e044684.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.05.059"},{"key":"2025120519352716000_11.5.e044684.47","doi-asserted-by":"crossref","unstructured":"Hur K , Price CPE , Gray EL . Factors associated with intubation and prolonged intubation in hospitalized patients with COVID-19. JAMA Otolaryngol Head Neck Surg 2020.","DOI":"10.1177\/0194599820929640"},{"key":"2025120519352716000_11.5.e044684.48","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/joim.13119","article-title":"Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID-19 patients in Michigan, United States","volume":"288","author":"Imam","year":"2020","journal-title":"J Intern Med"},{"key":"2025120519352716000_11.5.e044684.49","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1002\/oby.22859","article-title":"Association of obesity with disease severity among patients with coronavirus disease 2019","volume":"28","author":"Kalligeros","year":"2020","journal-title":"Obesity"},{"key":"2025120519352716000_11.5.e044684.50","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1002\/oby.22913","article-title":"Severe obesity as an independent risk factor for COVID-19 mortality in hospitalized patients younger than 50","volume":"28","author":"Klang","year":"2020","journal-title":"Obesity"},{"key":"2025120519352716000_11.5.e044684.51","doi-asserted-by":"crossref","unstructured":"Lassale C , Gaye B , Hamer M . Ethnic disparities in hospitalisation for COVID-19 in England: the role of socioeconomic factors, mental health, and inflammatory and pro-inflammatory factors in a community-based cohort study. Brain Behav Immun 2020.","DOI":"10.1016\/j.bbi.2020.05.074"},{"key":"2025120519352716000_11.5.e044684.52","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-020-01208-1"},{"key":"2025120519352716000_11.5.e044684.53","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2020.154262"},{"key":"2025120519352716000_11.5.e044684.54","doi-asserted-by":"crossref","unstructured":"Patel AP , Paranjpe MD , Kathiresan NP , et al . Race, socioeconomic deprivation, and hospitalization for COVID-19 in English participants of a national Biobank. Int J Equity Health 2020;19.doi:10.1186\/s12939-020-01227-y","DOI":"10.1186\/s12939-020-01227-y"},{"key":"2025120519352716000_11.5.e044684.55","unstructured":"Perez-Guzman PN , Daunt A , Mukherjee S . Report 17: clinical characteristics and predictors of outcomes of hospitalized patients with COVID-19 in a London NHS trust: a retrospective cohort study. London: Imperial College, 2020."},{"key":"2025120519352716000_11.5.e044684.56","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1966"},{"key":"2025120519352716000_11.5.e044684.57","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1111\/liv.14565","article-title":"Abnormal liver function tests predict transfer to intensive care unit and death in COVID-19","volume":"40","author":"Piano","year":"2020","journal-title":"Liver Int"},{"key":"2025120519352716000_11.5.e044684.58","doi-asserted-by":"crossref","unstructured":"Price-Haywood EG , Burton J , Fort D , et al . Hospitalization and mortality among black patients and white patients with COVID-19. NEJM 2020.","DOI":"10.1056\/NEJMsa2011686"},{"key":"2025120519352716000_11.5.e044684.59","doi-asserted-by":"crossref","unstructured":"Shah V , Ko Ko T , Zuckerman M , et al . Poor outcome and prolonged persistence of SARS\u2010CoV\u20102 RNA in COVID\u201019 patients with haematological malignancies; King\u2019s College Hospital experience. Br J Haematol 2020;190.doi:10.1111\/bjh.16935","DOI":"10.1111\/bjh.16935"},{"key":"2025120519352716000_11.5.e044684.60","unstructured":"Singh S , Khan A . Clinical characteristics and outcomes of COVID-19 among patients with pre-existing liver disease in United States: a multi-center research network study. Gastroenterol 2020."},{"key":"2025120519352716000_11.5.e044684.61","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1053\/j.gastro.2020.06.003","article-title":"Risk of severe coronavirus disease 2019 in patients with inflammatory bowel disease in the United States: a multicenter research network study","volume":"159","author":"Singh","year":"2020","journal-title":"Gastroenterology"},{"key":"2025120519352716000_11.5.e044684.62","doi-asserted-by":"crossref","unstructured":"Violi F , Cangemi R , Romiti GF , et al . Is albumin predictor of mortality in COVID-19? Antioxid Redox Signal 2020.doi:10.1089\/ars.2020.8142","DOI":"10.1089\/ars.2020.8142"},{"key":"2025120519352716000_11.5.e044684.63","unstructured":"England PH . Disparities in the risk and outcomes of COVID-19. London, UK: Public Health England, 2020."},{"key":"2025120519352716000_11.5.e044684.64","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-019-0782-0"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-044684","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T03:35:37Z","timestamp":1764992137000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-044684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":64,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,13]]},"published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1136\/bmjopen-2020-044684"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-044684","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.08.27.20183434","asserted-by":"object"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}